214 
Autogenous  Vaccines. 
{Am.  Jour.  Pharm. 
May,  1914. 
hardier,  more  freely  growing  organism  by  treating  the  culture 
medium  in  an  appropriate  manner,  but  unless  this  is  accomplished 
it  will  be  seen  at  once  how  useless  it  is  to  successfully  treat  a 
pyelitis  of  streptococcal  or  tubercular  origin  by  using  only  the 
B.  coli  in  the  vaccine  preparation.  Hence  the  failure  of  many 
autogenous  vaccines  that  are  bacteriologically  imperfect  or  in- 
complete. 
In  many  cases  of  chronic  gleet,  however,  the  gonococcus  is 
absent  and  the  catarrhal  inflammation  kept  alive  by  secondary  in- 
vaders, which  may  then  in  combination  serve  for  cure  in  absence  of 
the  primary  invader. 
After  getting  out  every  bacterial  group  contained  in  a  given 
specimen,  each  in  pure  culture,  these  should  then  be  studied  with  a 
view  to  their  share  in  the  production  or  continuation  of  the  disease 
in  question,  and,  guided  by  experience,  clinical  as  well  as  bacterio- 
logical, a  final  judgment  of  the  organisms  concerned  may  be  passed 
and  the  proper  ones  selected  for  use  in  the  vaccine.  They  may 
all  be  combined  in  a  single  ampoule  or  may  be  placed  singly  or  in 
pairs.  Only  the  lower  dosages,  however,  can  be  reached  by  making 
a  mixed  vaccine  composed  of  many  elements,  on  account  of  the 
combined  dosage  being  too  high  to  permit  of  safe  injection. 
We  can  now  proceed  to  prepare  the  vaccine,  in  which  the 
following  steps  are  concerned: 
1.  To  obtain  an  emulsion  containing  the  bacteria  in  purity — an 
emulsion  with  a  uniform  suspension  and  as  free  from  bacterial 
clumping  as  possible. 
2.  To  standardize  the  emulsion — that  is,  to  determine  how 
many  bacteria  are  contained  in  each  cubic  centimetre. 
3.  To  kill  the  bacteria  in  the  emulsion  and  then  tube  them — or 
4.  To  decide  upon  the  dosage  of  each  ampoule  or  set  of  am- 
poules ;  to  tube  them  still  alive  and  then  kill  them. 
5.  To  label,  effectively,  each  ampoule  and  place  them  in  sets 
of  ten  in  compartment  boxes  or  cartons,  the  lids  of  which  are  to  be 
specifically  marked  with  the  names  of  the  organisms  they  contain 
and  in  what  dosage,  and  most  particularly  with  directions  for  their 
use. 
6.  To  be  sure  that  all  "  controls  "  are  sterile  before  allowing 
the  vaccine  set  to  leave  the  laboratory  for  use. 
I  shall  not  in  this  paper  enter  in  detail  into  the  technic  required 
in  the  actual  preparation  of  the  vaccine,  but  I  want  to  say  a  word 
